Tell us your Ulcerative Colitis story
Have you been diagnosed with Ulcerative Colitis? (Optional)
Select One
Yes
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact relationships with family or caregivers? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact your daily exercise or other activities? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact your mental health? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Does Ulcerative Colitis impact your healthcare costs? (Optional)
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Yes
Somewhat
No
Not Sure
Not Applicable
Are you currently looking for a Ulcerative Colitis clinical trial? (Optional)
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Yes
No
Not Sure
Not Applicable
First Name
Last Name
Email
Phone (Optional)
Age (Optional)
Postal Code (Optional)
Gender (Optional)
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Male
Female
Transgender Male
Transgender Female
Gender Variant/Non-Conforming
Unspecified
How would you like to be contacted? (Optional)
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Phone Call
SMS
Text
Any
What would you like researchers to know about your experience with Ulcerative Colitis? (Optional)
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